本文選題：二腹肌后腹及莖突舌骨肌復(fù)合體 + 舌下神經(jīng)�。� 參考：《桂林醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：通過(guò)尸體標(biāo)本解剖獲得上頸椎前外側(cè)手術(shù)入路中所涉及的重要血管、神經(jīng)等相關(guān)組織結(jié)構(gòu)的詳細(xì)解剖學(xué)資料,明確其之間的毗鄰關(guān)系,為上頸椎前外側(cè)手術(shù)入路提供臨床參考。方法：選擇經(jīng)10%福爾馬林固定的顱頸完整的成人濕標(biāo)本20具(40側(cè)),模擬上頸椎前外側(cè)手術(shù)入路逐層解剖,詳細(xì)觀察上頸椎前外側(cè)手術(shù)入路中所涉及的重要血管、神經(jīng)等相關(guān)組織結(jié)構(gòu),并測(cè)量相關(guān)血管與神經(jīng)的長(zhǎng)度、管徑及毗鄰之間的距離,所得結(jié)果用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理。結(jié)果：1、喉上神經(jīng)內(nèi)支穿出動(dòng)脈鞘點(diǎn)與舌骨大角的位置關(guān)系有三種：①平舌骨大角：占12.5%(5/40)。②舌骨大角上方5mm以?xún)?nèi)：占17.5%(7/40)。③舌骨大角下方10mmm以?xún)?nèi):占70%(28/40)。喉上神經(jīng)內(nèi)支從穿出點(diǎn)到穿入甲狀舌骨膜的距離：左測(cè)(22.3±3.2)mm(16.5～23.9mm),右側(cè)為(23.2±3.8)mm(16.6-25.9mm),兩側(cè)合并后的距離為(22.7±3.5)mm(16.5～25.91mm)。外支的直徑(0.7±0.11)mm(0.4～1.1),與甲狀腺上動(dòng)脈形成神經(jīng)血管束,亦經(jīng)甲狀舌骨膜穿入,分布于喉部組織。2、舌下神經(jīng)從舌下神經(jīng)管出顱,向前內(nèi)走行,在枕動(dòng)脈處,發(fā)出一降支與C2及C3神經(jīng)前支的降支結(jié)合形成頸袢,支配舌骨下肌群；在下頜角處,呈弓狀走行于二腹肌后腹及莖突舌骨肌深面,并與之有2次交叉,之后向前彎曲到下頜舌骨肌的深面,發(fā)出分支支配除腭舌肌以外的全部舌肌。3、二腹肌后腹及莖突舌骨肌位于頸深筋膜淺層及中層之間,兩者平行相伴而行,容易辨認(rèn),其深面組織由外向內(nèi)依次為頸內(nèi)靜脈、副神經(jīng)、舌下神經(jīng)、枕動(dòng)脈、頸外動(dòng)脈、面動(dòng)脈等。4、舌骨大角周?chē)闹匾Y(jié)構(gòu)有甲狀腺上動(dòng)脈、舌動(dòng)脈、喉上神經(jīng)及舌下神經(jīng),它們與舌骨大角尖的最短距離分別為(12.5±3.9)mm(6.9～18.7)；(0.4±1.6)mm(0.2～2.5)；(5.2±1.4)mm(1.6～10.8)；(5.0±1.7)mm(1.6-9.7)。5、在解剖過(guò)程中發(fā)現(xiàn)將舌下神經(jīng)向頭側(cè)牽開(kāi),喉上神經(jīng)向尾側(cè)牽開(kāi),頸動(dòng)脈鞘向外側(cè)牽開(kāi),內(nèi)臟鞘(舌骨、食管和氣管)向內(nèi)側(cè)牽開(kāi),即可以形成類(lèi)似楔形的“窗口”,“窗口”直接對(duì)應(yīng)的部位為C2/C3椎間盤(pán)及C3椎體,結(jié)合頸部過(guò)伸體位及用拉鉤牽拉,可暴露最大范圍：向上達(dá)寰椎前弓,向下達(dá)頸3椎體下緣,兩側(cè)可以暴露至橫突。結(jié)論：1、在上頸椎前外側(cè)手術(shù)入路中,二腹肌后腹及莖突舌骨肌復(fù)合體、舌骨大角為尋找舌下神經(jīng)及喉上神經(jīng)重要的標(biāo)志,術(shù)中尋找到這兩根神經(jīng)后,對(duì)其游離并加以保護(hù),可以減少損傷機(jī)率。2、通過(guò)以舌下神經(jīng)、喉上神經(jīng)、頸動(dòng)脈鞘及內(nèi)臟鞘(舌骨、食管和氣管)組成的類(lèi)似楔形的“窗口”暴露上頸椎,可以獲得較理想的顯露,并且該概念的提出,為進(jìn)一步應(yīng)用微創(chuàng)器械進(jìn)行上頸椎手術(shù)提供了一個(gè)良好的通道。
[Abstract]:Objective: to obtain the anatomical data of the important blood vessels, nerves and other related tissue structures involved in the anterolateral cervical vertebrae approach by cadaveric dissection, and to clarify the relationship between them.To provide a clinical reference for the upper cervical anterolateral approach.Methods: 20 adult adult wet specimens fixed with 10% formalin were selected to simulate the anterolateral approach of upper cervical vertebrae. The important blood vessels involved in the approach were observed in detail.The length, diameter and distance between the nerve and the nerve were measured. The results were analyzed by SPSS13.0 software.Results: 1. There are three types of relationship between the sheath point of the internal branch of the superior laryngeal nerve and the position of the great angle of the hyoid bone. There are three types of 1: 1, equal to the great angle of hyoid bone: 12.5% or 5 / 40. 2 within 5mm above the large angle of hyoid bone: within 17.5% 40.3% of 10mmm below the great angle of hyoid bone: 70% within 28% 40% of total hyoid angle.The distance between the internal branch of the superior laryngeal nerve from the point of perforation to the periosteum of the thyroid tongue: left 22.3 鹵3.2mm. 16.5 鹵23.9mm, on the right, 23.2 鹵3.8mm, 16.6-25.9 mm, and the distance after bilateral union was 22.7 鹵3.5mm, 16.525.9mm, respectively.The diameter of the external branch was 0.7 鹵0.11mm ~ (0.11) m ~ (-1), which formed a neurovascular bundle with the superior thyroid artery, and was also perforated through the periosteum of the thyroid tongue and distributed in the laryngeal tissue. The hypoglossal nerve came out of the hypoglossal nerve canal from the cranium and went forward inside the occipital artery.The descending branch is combined with the descending branch of the anterior branches of C2 and C3 nerves to form a cervical loop, which innervates the subhyoid muscle group; at the mandibular angle, it is arcuate along the deep surface of the posterior abdomen and stylohyoid muscle of the bicentric muscle and the styloid hyoid muscle, with which it intersects twice.It then bends forward to the deep surface of the mandibular hyoid muscle, emits branches that innervate all the lingual muscles except palatoglossal muscle .3.The posterior abdomen and stylohyoid muscles of the diabs are located between the superficial and middle layers of the deep cervical fascia, and the two are parallel to each other and are easily recognizable.The internal jugular vein, accessory nerve, hypoglossal nerve, occipital artery, external carotid artery, facial artery, etc.The shortest distance between them and the tip of the hyoid was 12.5 鹵3.9mm ~ 6.9m ~ (-6.9m) ~ 18.7m ~ (-1) ~ (0.4 鹵1.6) mm ~ (-1) ~ (2) ~ (2) ~ (2) ~ (2) ~ (2.5) 鹵1.610.8m ~ (-1) ~ (5.0 鹵1.7) mm ~ (-1) ~ 1.6-9.7mm ~ (-1) respectively. In the anatomic process, it was found that the hypoglossal nerve was pulled sideways, the superior laryngeal nerve was opened to the tail, the carotid artery was opened to the lateral side, and the visceral sheath (hyoid, esophagus and trachea) was opened to the medial side.That is to say, a wedge-like "window" can be formed. The "window" directly corresponds to the C2/C3 intervertebral disc and the C3 vertebra. Combined with cervical hyperextension and pull with a pull hook, the largest range of exposure can be obtained: reaching the anterior arch of atlas upward to the lower margin of the cervical 3 vertebra.Both sides can be exposed to transverse processes.Conclusion: in the anterolateral approach of upper cervical vertebrae, the posterior ventral and styloid hyoid muscle complex of the bicentric muscle and the large angle of hyoid bone are important markers for searching for hypoglossal nerve and superior laryngeal nerve.It can reduce the chance of injury by exposing the upper cervical vertebrae with a wedge of hypoglossal nerve, superior laryngeal nerve, carotid sheath and visceral sheath (hyoid, esophagus and trachea).This concept provides a good channel for the further use of minimally invasive instruments for upper cervical surgery.
【學(xué)位授予單位】：桂林醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R322

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本文編號(hào)：1747469